The Maternal Management of Children, in Health and Disease. - Thomas Bull, M.D.
From the moment dentition begins, pressure on the gums will be found
to be agreeable to the child, by numbing the sensibility and dulling
the pain. For this purpose coral is usually employed, or a piece of
orris-root, or scraped liquorice root; a flat ivory ring, however, is
far safer and better, for there is no danger of its being thrust into
the eyes or nose. Gentle friction of the gums, also, by the finger of
the nurse, is pleasing to the infant; and, as it seems to have some
effect in allaying irritation, may be frequently resorted to. In
France, and in this country also, it is very much the practice to dip
the liquorice-root, and other substances, into honey, or powdered
sugar-candy; and in Germany, a small bag, containing a mixture of sugar
and spices, is given to the infant to suck, whenever it is fretful and
uneasy during teething. The constant use, however, of sweet and
stimulating ingredients must do injury to the stomach, and renders
their employment very objectionable.
THE MANAGEMENT OF THE INFANT IN DIFFICULT TEETHING.
In the child which has been partly or altogether brought up by hand,
or who is of a feeble and delicate constitution, or imbued with any
hereditary taint, the process of dentition will be attended with more
or less difficulty, and not unfrequendy with danger.
SYMPTOMS.--The symptoms of difficult dentition are of a much more
aggravated description than those which attend the former case; and it
is right that a mother should, to a certain extent, be acquainted
with their character, that she may early request that medical aid,
which, if judiciously applied, will mitigate, and generally quickly
remove them.
Difficult dentition will be attended with painful inflammation and
swelling of the gum, which is hotter, of a deeper red, than natural,
and intolerant of the slightest pressure. There is often great
determination of blood to the head, which a mother may recognise by the
cheeks being red, hot, and swollen; the eyes red, irritable, and
watery; and the saliva running from the mouth profusely. The fever is
great, and the thirst extreme. The child is at one time restless and
irritable, and at another heavy and oppressed: the sleep will be
broken, and the infant frequently awake suddenly and in alarm from its
short slumbers. Such are the chief symptoms of difficult teething, and
which will be present to a greater or less degree.
TREATMENT.--As most of the above symptoms are induced by the painful
tension of the gum, it would seem that the most rational mode of
attempting their relief is by freely lancing the swollen part. Great
prejudices, however, still exist in the minds of some parents against
this operation. They think it gives great pain, and, if the tooth is
not very near, makes its coming through the gum subsequently the more
difficult.
With regard to the first objection, the lancet is carried through the
gum so quickly, that this is hardly possible; and the fact that the
infant will often smile in your face after it is done, although
previously crying from pain, is sufficient evidence that it is not a
very painful operation. In reference to the second, that the scar which
ensues, opposes, by its hardness, the subsequent progress of the tooth,
it is quite groundless; for cicatrices, like all other new-formed
parts, are much more easily absorbed than the original structure.
Of the practical utility and perfect safety of this operation we have
ample proof in its daily performance with impunity, and in the instant
relief which it often affords to all the symptoms.
Mere scarifying the gums is sometimes all that is required, and will
afford great relief. This operation, therefore, should not be opposed
by the mother. She, at the same time, should be acquainted with its
precise object, lest the speedy return of the symptoms, and the non-
appearance of the expected tooth, might tend to bring the operation of
lancing the gums into disrepute.
The parental management of the infant, then, and by which much of the
pain and difficulty of teething may be removed or alleviated, consists
in attending to the following directions:--
FIRST, TO THE STATE OF THE MOUTH.--To this it is an important part of
the mother's duty to pay especial attention; and, by so doing, she will
save her child much suffering. The condition of the mouth should be
carefully inspected from time to time; and should a swollen gum be
discovered, it should immediately be attended to, not waiting till
constitutional symptoms appear before she employs proper aid for her
child. For this purpose the mother should make herself familiar with
the appearances of the gum under distention and inflammation; a matter
of no difficulty, accompanied, as this condition usually is, by a
profuse secretion of saliva, heat of mouth, and at a time when the age
of the child justifies the supposition that it is about to cut its
first tooth, or, if it have some teeth, that others are about to appear.
SECONDLY, TO THE FOOD.--If a child is teething with difficulty, it
should always have its quantity of nourishment diminished. If it is
being fed, as well as nursed at the breast, at the time, the former
should be immediately withheld: if it is being fed alone, the only
kind of food that should be allowed is milk and water. These cases are
much aggravated by the not uncommon habit of parents giving the infant
food whenever it cries from the irritation attending upon the process;
and thus a slightly difficult dentition is converted into serious
disease.
THIRDLY, TO THE STATE OF THE BOWELS.--These must be carefully watched,
that they may not become confined; it being necessary that they should
be gently relaxed at this time. If a slight diarrhoea is present, it
must not be checked; if it pass beyond this, however, medicine must be
had recourse to, and great benefit will also arise from putting the
child into a warm hip-bath, and warmly clothing the body, but keeping
the head cool.
FOURTHLY, TO THE HEAD.--The infant's head should be washed with cold
water night and morning, and no other covering than that which nature
has provided should be put upon it when within doors or asleep; and on
no occasion should warm felt or velvet hats be worn during mild or warm
weather, straw or white hats being much lighter and cooler. The child
should be much in the open air.
The sponging of the infant's body daily, either with cold or tepid
water, must depend upon the season of the year and constitution of the
child, as well as upon other circumstances. Sponging the head with cold
water night and morning is almost invariably atttended with great
benefit, and may be resorted to in every case without fear; and now and
then the use of the warm hip-bath, for several days together, will be
ordered by the physician, which, by acting upon the skin, diminishes
the determination of blood to the head, and thus forms an important
source of relief.
FIFTHLY, OF CONVULSIONS.--If they should occur, and they are not
unfrequently excited by difficult teething, and then give great alarm
to the parent, relief will be afforded by immersing the hips, legs,
and feet of the infant in water as warm as can be borne, and at the
same time applying over the head and temples a piece of flannel wet
with cold water. I have also often cut the fit short by sprinkling cold
water in the child's face while in the bath. The gums should always be
looked to, and if they appear swollen, and painful, at once lanced. I
have known the most formidable convulsions to cease immediately after
this operation.
SIXTHLY, OF THE USE OF OPIATES.--It is the practice with some nurses
to administer narcotics to quiet infants while teething. It is not only
objectionable, but, from the uncertain effects of sedatives upon
infants, a very dangerous practice, and they ought never to be given,
except at the suggestion of a medical man. It is far better, if the
child is restless at night, to have it frequently taken out of its cot,
and carried about in an airy room; for the cool air, and change of
posture, will do much to allay the feverishness and restlessness of the
child.
From these few hints, it must have been seen how much the sufferings
from teething may be mitigated by judicious management. That, if the
parent is able to support her infant upon the breast alone, teething
will be found comparatively an easy process, and unattended with
danger; the mother thus reaping a delightful reward for all the
anxieties and privations nursing necessarily involves. That the child
brought up partially, or entirely, by hand will always pass through
dentition with more or less of pain and difficulty; but that even here,
if the diet has been properly regulated, much less suffering and
inconvenience will arise than when less attention has been paid to it.
And, lastly, that, when teething is difficult, how highly important it
is to call in proper aid at an early period, and to carry out fully the
directions of the medical attendant, allowing no foolish prejudices to
interfere with his prescriptions and management.
If I stood in need of any argument to impress upon the mind of a
parent the importance of attending to the last injunction, I would
simply state, that its neglect is but too frequently the cause of
disease of the brain, terminating in death, or a state of idiotcy far
worse than death, of which I know more than one living instance.
It may be as well to add, that eruptions about the ears, head, face,
and various parts of the body, very frequently appear during the
process of the first teething.[FN#23] If they are slight, they should
be left alone, being rather useful than otherwise; if they are
troublesome, they must receive that kind of attention from the parent
which will be pointed out under the chapter on diseases. The same
remark applies to enlargements of the glands of the neck, which
frequently appear at this time.
[FN#23] In some infants a rash always precedes the cutting a tooth.
Sometimes it appears in the form of hard elevated pimples as large as
peas; in other instances in the form of red patches, of the size of a
shilling, upon the arms, shoulders, and back of the neck. They are
always harmless, require no particular attention, and prevent, I doubt
not, more serious complaints.
SECT. II. HINTS UPON THE PERMANENT OR ADULT TEETH.
Parents are not sufficiently alive to the importance of attending to
the condition of the mouth of their children at the period of changing
the first for the second set of teeth; they do not seem to be aware
how much the comfort, appearance, and future health of the child
depends upon it. Nor do they subsequently impress upon the minds of
their children how necessary, on their part, is the observance of
certain rules for the preservation of the teeth, and how distressing
are the effects which result from their neglect. It is proposed, here,
to say a few words for the information and guidance of the parent upon
this subject.
THE MANNER IN WHICH THEY APPEAR.
The change of the temporary for the permanent or adult teeth
commences, in the majority of instances, at about seven years of age;
occasionally it occurs as early as five, and as late as eight years and
a half. The necessity which exists for this change, and the mode by
which it is effected, are striking and beautiful; it is, however, not
our object to enter fully upon its consideration here.
It has already been observed, that the infant is born with the
rudiments of two sets of teeth in the jaw, although neither make their
appearance till long after birth. The time when, and the manner in
which the first set appear has been pointed out. Now although these
admirably answer the purposes for which they were given up to the
seventh year, after this period they fail to do so: they are not
sufficiently numerous,--in their structure they are not strong or
durable,--nor is their power of mastication sufficiently great.
They are not sufficiently large or numerous. If the mouth of a child
at this age is examined, it will be seen, that a considerable interval
has taken place between the teeth in consequence of the growth and
expansion of the face; hence a larger set has become necessary to fill
the arch. But it may be asked, do not the teeth grow with the growth of
the body? and if not, why is it so? They do not, and for this reason:
the important office which these organs are destined to perform requires
that they should be composed of a substance too dense and of too low
an organization to allow of any subsequent growth and enlargement. Thus
the size of the teeth is determined and acquired before they make their
appearance through the gums. This being the case, it will be readily
seen, that the teeth which would be of appropriate size in the mouth of
the infant, would be quite inadequate to the enlarged dimensions of the
adult; hence the necessity of a second set, exceeding in number, and
size the teeth of the first.
That a necessity also exists at this age, that the weak and delicate
teeth of childhood should be exchanged for a set stronger and more
durable in their structure, more robust and more powerful, will be
sufficiently apparent, if we only recollect the great change which has
gradually been taking place in the nature of the food of the two epochs
of childhood and adult age.
The second set, or permanent teeth, then, lying under the milk-teeth
and hidden in the jaw, undergo in this situation their full
developement, before they appear above the gum. This occurrence
commences about seven years of age, at which period the first set
begin to fall out from their roots becoming absorbed, and no longer
retaining their hold of the jaw; to be entirely replaced in the course
of a few years by the permanent set, which thus succeeds them. The
first teeth of this set which make their appearance are the large
double teeth, which emerge from the gum immediately behind the last of
the temporary set. Next the two front teeth of the lower jaw fall out,
and are succeeded by two others of similar character and form, but of
larger size; then the two corresponding teeth of the upper row are cast
off, and their place supplied; shortly after the teeth immediately
adjoining these; then the double teeth of the first set are exchanged
for their smaller successors of the second. The eye-teeth after a time
begin to make their appearance; and then more double teeth; making in
all twenty-eight teeth, and occupying in their developement from the
seventh to the fourteenth year of age. They are not, however, yet
complete; for between the latter date and the twenty-first year four
more teeth appear, called the wisdom teeth, making the adult set or
permanent teeth to amount in all to thirty-two teeth. It should be
observed, that whilst this is the most usual course in which this set
appear, the line of succession is sometimes different.
THEIR VALUE AND IMPORTANCE.
It would seem almost unnecessary to say a word upon so self-evident a
truth, and yet perhaps the full extent of this statement is not
generally appreciated. It has not, perhaps, occurred to the minds of
all, that upon the right position and arrangement of the teeth the
beauty and expression of the countenance much depends. But so it is;
for however regular and perfect the general features, if the teeth are
irregular or deficient, an unpleasing expression, proportionate to the
extent of the displacement, is inevitably produced. Now every mother
should be alive to this fact, that she may early apply to the dentist
to have any error of the above nature rectified, before it is too late.
On their complete and entire state also depends the perfection of
utterance and articulation. The child, for instance, makes no attempt
at articulation until it has acquired several teeth; this faculty
becomes also exceedingly imperfect during the process of changing them;
from this time it continues to improve, until again it is permanently
impaired in old age, when they are finally lost. And so again, if a
child lose merely a single tooth from the front of its mouth, lisping
will result; or if a supernumerary or irregular tooth be present, the
articulation will be abrupt and imperfect:--the former plainly showing
the importance of the entireness of the series, and the latter, the
necessity of regularity in their arrangement and position.
The teeth, however, are chiefly important in relation to the part they
sustain in connection with digestion, viz. the mastication of the food.
By this act the food, after being received into the mouth, is mixed
with the saliva and broken down, till it becomes of an uniform pulpy
consistence, fit for being easily swallowed, and acted upon by the
gastric juice on its arrival in the stomach. That due mastication of
the food is essential to healthy digestion, which will be promoted or
retarded in exact proportion as it approaches or falls short of this
point, is a fact so generally known as scarcely to need comment.
Suffice it to add, that, if food be introduced into the stomach
unmasticated, the gastric juice will only act upon its surface; and
after a number of hours it will be either rejected by vomiting, or pass
on into the intestine, to give rise to cholic, bowel complaints, or
flatulence, and very frequently in children to a serious attack of
convulsions.
THEIR MANAGEMENT AND PRESERVATION.
IRREGULARITY OF ARRANGEMENT AND POSITION.--Every parent ought to have
the mouth of her child inspected occasionally, during the advance of
the permanent teeth, that any irregularity in their position or
arrangement may be prevented. And it is equally her duty to see to it,
that she choose a competent person to do this, since great mistakes are
not unfrequently made in this matter, and which themselves become the
source of evils far more serious than those they are intended to
obviate. "I have known," says Mr. Bell, "no less than eight or even ten
firm teeth forcibly removed from the jaws of a child at once, when
there was not the slightest reason to apprehend any evil result from
their being left alone." Here there was a most cruel, because
unnecessary, infliction of pain, as well as great hazard incurred of
seriously injuring the permanent teeth by interfering with the
secretion of their enamel. And besides all this there is another and
yet greater evil, for, if the temporary teeth be removed, before the
permanent ones are so advanced as to be ready to occupy their
situation, the arch of the jaw will assuredly contract, and when,
subsequently, the permanent teeth are fully formed, there will not be
room for them to range in their proper situation. Thus the operation
which was intended to prevent irregularity becomes the cause of its
occurrence, and that in its very worst form, producing a want of
accordance between the size of the teeth and that of the jaw.
The eye-teeth generally occasion most anxiety to a parent, from the
prominent position in which they present themselves; but in the
majority of cases nothing but time is required to reduce them to their
proper station. But, whatever may be the peculiarities of each
individual case, the dentist will decide what may be required; only, I
would again repeat, do not neglect the occasional inspection of the
mouth at this age, if you regard the future comfort and appearance of
your child.
THEIR PRESERVATION.--The preservation of the teeth requires attention to
several points; the first and principal of which is, to enforce the
habit in the child of thoroughly cleaning the teeth by means of water
and a brush night and morning, and rinsing out the mouth after each
meal. The brush should not be very hard, as it will not only be more
difficult to clean the interstices between the teeth, the
part in which the tartar[FN#24] is most likely to be deposited, but by
its friction, will occasion the gradual absorption of the gum and the
exposure of the neck of the teeth. The hair of the brush should be firm
and elastic, and not too closely set.
[FN#24] A sort of calcareous substance, which becomes deposited at
the roots of the teeth, from a want of proper attention to
cleanliness; and, if allowed to remain, will destroy first their
beauty, and then the organ itself.
TARTAR.--If there is a tendency to the formation of tartar, then it will
be necessary to have recourse to some tooth-powder. Tooth-powders,
however, must be chosen with care, as many of them are composed of
substances highly injurious to the teeth. "Many of the tooth-powders
which are offered for sale, with the promise of rendering the teeth
beautifully white, perform, for a time, all that is promised, at the
expense of permanent and irremediable injury to the teeth; for they
often contain a quantity of tartaric or other acid, which effects a
gradual decomposition of the enamel."[FN#25] Prepared chalk is one of
the simplest and best tooth-powders.
[FN#25] Bell on the Teeth.
The following form, also, may be used with advantage:--
Prepared chalk, three ounces;
Orris root, powdered, half an ounce;
Powdered myrrh, half an ounce;
Cuttle fish, powdered, one ounce;
Essential oil of cinnamon, four drops.--Mix.
The best preservative, then, against the formation of tartar, is to
see that the child cleans his teeth thoroughly night and morning with
the brush, powder, and water, and also (if possible) that he rinses out
the mouth after each meal.
If the gums should be tender, irritable, and bleed (as is frequently
the case when an individual gets out of health, or the tartar
accumulates) the mouth may be washed night and morning with a tumbler of
tepid water, containing from ten to twenty drops of the tincture of
myrrh, and the same quantity of spirits of camphor; or the following
form may be used:--
Alum, one drachm and a half;
Tincture of myrrh, two drachms;
Camphor mixture, five ounces and a half.--Mix.
ACIDS.--The use of acids to the teeth cannot be too strongly deprecated:
they decompose their substance, and lead to their rapid decay. Hence
the whiteness produced by acid tooth-powders and washes is not less
deceitful than ruinous in its consequences. As has been just observed,
they perform all that their vendors promise, causing the teeth, for a
little while, to become very white and beautiful in their appearance,
but, at the same time, injuring them irremediably: the enamel becomes
gradually decomposed, the bone of the tooth exposed, and its death is
the inevitable consequence.
It is therefore of great importance when acid medicines are ordered
for children that they should be taken through a glass tube, to prevent
their coming in contact with the teeth. From a want of this precaution,
I know a lady (and there are many such instances) who once had as sound
and fine a set of teeth as any one could boast of, but from this cause
has had nearly the whole of the upper row destroyed. She was in
delicate health: it was judged requisite that she should take for a
considerable time (with other medicines) sulphuric acid; but the glass
tube was not thought of, and the consequences followed which have been
described.
CALOMEL.--This medicine, as it is frequently given, alone, or in the
little white powders, in infancy and childhood, by mothers and nurses,
is productive of serious and indeed irremediable injury to the teeth.
"The immoderate use of mercury in early infancy produces, more perhaps
than any other similar cause, that universal tendency to decay, which,
in many instances, destroys almost every tooth at an early age. It is
certainly not unimportant to bear this fact in mind, in the
administration of this sovereign remedy, this panacea, as many appear
to consider it, in infantile diseases."[FN#26]
[FN#26] Bell on the Teeth.
HEAT AND COLD.--The teeth are exceedingly apt to suffer from sudden
variations of temperature. Fluids, therefore, should never be taken
into the mouth so hot or so cold as to produce the slightest pain; and,
for the same reason, the water with which the mouth is cleansed should
in winter be always warm or tepid. When ices are taken, the precaution
of placing them in the centre of the mouth, so as to prevent contact
with the teeth, should be carefully observed.
There are many other causes which might be mentioned as tending to
induce decay of the teeth, but their consideration here is purposely
avoided.
It is hoped that enough has been said to draw the parent's attention
to the subject of the teeth, to prevent their neglect, and yet at the
same time to induce a cautious management.
CHAP. IV.
HINTS FOR THE EARLY DETECTION OF DISEASE IN THE CHILD BY THE MOTHER.
Life is soon extinguished in infancy. At this epoch any disease is
formidable, and must be met most promptly. It is either sudden and
active in its assaults, or comes with slow and insidious approach. The
first signs of its coming on are not always visible to an unpractised
eye: it may have made dangerous advances before the mother's mind is
awakened to its presence; and medical aid may be solicited when
remedies and advice are no longer of any avail.